Reaffirmed ACA Shifts Business as Usual

Regardless of how health executives called the recent King v. Burwell coin toss, the Supreme Court decision reaffirms that the Affordable Care Act (ACA) Federal subsidies stand. If their financial cushion was lost, 4.5 million Americans—almost 50% of those who enrolled in ACA initially—would have missed health-plan premium payments and payers might have raised premiums for all. That would have been a hard landing for this promising program. Now, with that distraction gone, the big health risk is unchecked chronic disease within Federal poverty-level communities. Health marketers unite!

Who are the health customers who joined the insured community? Nationally, 43% of the adults who make up this population are White non-Hispanics, 24% are Hispanic and 27% are Black. These here-to-stay customers require marketing communication leaders to mobilize around multicultural initiatives and population health programs. This is not about good customer service—but it is about business growth and budget burden imperative. According to the U.S. Health and Human Services, five percent of the nation’s population accounts for 50% of all health expenditures.

Intervention Required!

These are not needle-in-the-haystack customers. Most of the nation’s economically challenged populations reside in big-market urban pockets. To get savvy quick, health companies must learn from Medical “Hot Spotters.” Like hurricane trackers, these population-health gurus are headed toward the nation’s medical storms in which high ER visits, and higher asthma, diabetes and heart disease rates demand disease awareness and intervention. In these communities, soaring cost is not attributed to pricy medicines. Cost reduction involves ensuring provider access and drug compliance. Under ACA, payers have an incentive to invest and reduce disease burden—and pharma is their ally!

Now with the ACA firmly underway, the circle of Medical Hot Spotters extends beyond pioneer Camden Coalition’s Dr. Jeffrey Brenner’s efforts and includes patient advocacy groups such as the American Heart Association and the American Diabetes Association, which have made this health-challenged population a priority. Payers are also jumping into the wellness and access effort with Blue Cross/Blue Shield Michigan and Kaiser, among the many, making diversity programming a strategic imperative.

Improving Outcomes: What Does It Take?

What can pharmaceutical company leaders do? Doing well in the ACA environment requires shifting business models from selling to patient care. Companies including Merck and Bristol-Myers Squibb now stand shoulder-to-shoulder with providers and advocacy groups and are learning firsthand about how lifestyle changes and awareness improve outcomes.

Franchise units are drawing from community statistics to better understand how unchecked illness—without care coordination—ups costs. Suddenly, local policymakers, physicians, pharmacy leaders and pharma are working together to get therapy into the hands of those most in need and to turn healthcare into a customer service. Payers, knowing that smartphones are in the hands of their members, are using social media to educate. Digital communication is a recognized lifesaver.

Health sector brand and franchise champions need a clear case for how medicine provides value. It is as simple as comparing medical noncompliance to compliance in these communities where expanded Medicaid ACA programs will change the health landscape. Health marketers unite!


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